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Postdoctoral researcher Wei Zhang discusses the article “Peripheral artery disease prevention: Saving limbs and lives.” Wei explains how peripheral artery disease acts as a silent burden on the “life-highway” vessels of the body and why amputation rates are tragically rising by nearly 9 percent annually despite medical advancements. The conversation highlights the critical gap in early diagnosis caused by a “wait-to-see” mentality and exposes the deep socioeconomic disparities that leave marginalized communities at higher risk for limb loss. Wei outlines simple, proven prevention strategies that can save the health care system billions while preserving the fundamental human dignity of mobility and independence. Listen to learn how becoming the first guardian of your own vessel health can change the trajectory of your life.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Wei Zhang. She is a postdoctoral researcher. Today’s KevinMD article is “Peripheral artery disease prevention: saving limbs and lives.” Wei, welcome to the show.

Wei Zhang: Thank you so much for having me. It is a great opportunity to talk about my topics here.

I would like to give a brief introduction of myself. I am a medical scientist in cardiovascular medicine. I received my clinical training in vascular surgery in China and also research training in both China and Japan. Currently, I work as a researcher at Yale University.

My work mainly sits on the intersection of vascular disease surgery and the long-term patient outcomes. I work on vascular graft building and the optimization of existing cardiovascular devices. To guide my work, I follow very closely the patient outcomes in the real world.

Patients with peripheral artery disease are one population that I have paid particular attention to. Peripheral artery disease is a chronic, progressive disease. However, limited early diagnosis and access to advanced treatments may lead to devastating outcomes, which is limb loss.

It has been attracting attention now because the rate of limb losses has increased more and more in recent years. This is especially true according to the study that I talked about in this op-ed. This study has been led by Dr. Ing at the State University of New York. They tracked patients who had amputations from 1993 to 1999 and up to 2023 in the U.S. They found that after years of decline until 2010, the trend just reversed and showed a big increase of 9 percent per year.

It kind of caught my attention because we have seen lots of technical innovations in the past two decades. But after 2010, the trend of amputation reversed again. So this motivated me to write this op-ed to let me step back and ask what really does better for our patients in clinical practice and what we can do to make those patients have better outcomes for public health.

Kevin Pho: So in your article you mentioned that there is a 9 percent annual rise in amputation rates from peripheral artery disease currently. How often is peripheral artery disease being screened? Do you feel like it is commonly being screened? Do we have any data suggesting how often peripheral artery disease is being screened in a primary care setting?

Wei Zhang: There is no specific data about that, but the underdiagnosis of artery disease is still a major issue, especially in primary care. Patients sometimes present to primary care and talk about their symptoms. The health care workers maybe think it is not serious enough and we can wait to see. But after they finally feel those severe symptoms like unhealed sores and finally transfer to the vascular specialist, they find there is less chance for limb salvage and it leads to limb loss.

Before they present to primary care, some patients may feel leg pain and numbness but they don’t take it very seriously. So when they present to health care workers, sometimes it is late stage of development and you really have few choices for treatment.

Kevin Pho: In your article, you talk about socioeconomic status and sometimes that affects the complications of peripheral artery disease. Talk to us about some of those disparities.

Wei Zhang: Yeah, actually this is a very critical factor that has impacted those limb loss disparities, especially among low-income zip codes. Most Black people, Hispanic, and Asian patients have a relatively higher limb loss rate compared to white people.

I think there are two factors to this problem. One is that socioeconomic status is very important. For those low-income patients, usually they have limited access to primary care. When they finally present to primary care, the development has been late stage and leads to unnecessary limb loss outcomes.

Another situation is the shortage of the primary care workforce. The U.S. health care system relies very heavily on immigrant health care workers, especially for those underserved and rural areas where immigrant health care workers are disproportionately represented.

Recent data has shown that one in five U.S. health care workers are immigrants. In the current situation, the restriction of immigrants will also impact the health care workforce. Such a gap, once it has formed, given the long term of medical training, will be more difficult to fill. So I think both parts, patient economic situation and also the shortage of primary health care, are related to those disparities.

Kevin Pho: In the primary care setting in the exam room, what are some typical symptoms that would make a clinician think about screening for peripheral artery disease? Just give us some basic stories and how patients may present.

Wei Zhang: Firstly, you need to pay attention to those symptoms like limb pain when they walk. They cannot walk as fast as they used to. Also, they may have numbness and cannot really feel the temperature due to neuropathological changes.

You also need to screen for comorbidities. If they have high blood sugar, hyperlipidemia, or hypertension, you need to pay attention to those patients. For screening tests like ABI, maybe primary care is not equipped with those instruments. Once you suspect or want a patient to do some advanced screening, you can directly transfer them to the vascular specialist. They have vascular labs to provide equipment to further assess the vascular condition of those patients.

Kevin Pho: And you mentioned ABI that stands for ankle-brachial index. It is the ratio of the blood pressures in the brachial artery and the ankle that could sometimes suggest peripheral artery disease. Now, you talk also about some of the technology that we have today when it comes to treating peripheral artery disease. So tell us some of the things that are new that we didn’t have previously.

Wei Zhang: Over the past two decades, endovascular equipment has seen lots of innovation, especially for vascular surgery. Patients don’t really need to go through open surgery. They just use those endovascular procedures to get minimally invasive treatment to reopen their vessel and recover blood flow.

Actually, I was surprised because with the innovation of technology, you should see a decline in limb loss and those devastating outcomes. But it turns out that even with those innovations, you still see the increase of limb loss. Early diagnosis is one point. Another point triggered by the discussion about this study is that now there are more specialties like radiologists and cardiologists who are also involved in endovascular procedures.

In different scenarios, people have different indications. Also, the treatment threshold will vary among those different specialties. Sometimes when those tools are available, we don’t really think too much about the future plan. That means we really want to achieve instant perfect blood flow at the moment. But with so many treatments, it actually leaves less room for future treatment plans.

It is also one point considered by some specialists currently. We are seeing that maybe doing more is not doing better. We really need to think about the future treatment chance when we assess the current situation.

Kevin Pho: So it sounds like there is a spectrum of treatment options. It is not just straight to surgery. Like you mentioned, interventional radiology has some less invasive treatment options as far as you know regarding outcomes data regarding these different modalities to treating peripheral disease.

Wei Zhang: Among different specialties, there is no data comparing outcomes. But people have followed up comparing open surgery and endovascular procedures. People are more considering different endovascular procedures for certain diseases. When we use the drug-eluting balloon or drug-eluting stent to treat those patients, they usually compare different endovascular procedures. The trend of endovascular procedures in clinical practice is now more popular.

Kevin Pho: You talk about the economic impact when it comes to screening for peripheral artery disease. You give a number, 11 billion dollars. That is the financial burden of limb loss. So talk more about the economic impact when we screen for this earlier.

Wei Zhang: If you really screen earlier, patients really just need to use medication treatment. Or you can directly use endovascular or open procedures when the disease has advanced. Those are actually cheaper compared to limb loss surgery because when the disease has developed to that stage, it cannot save the limb. You need to do the amputation.

After amputation, you need to join an amputation program. You also have lots of economic burdens when it comes to your personal life. So compared to early treatment just for medication or endovascular or open vascular surgeries, limb loss surgery and the following personal life costs are much higher compared to early intervention.

Kevin Pho: So if I am a patient and I am listening to you on this podcast, tell me some of the signs and symptoms or even some of my demographic characteristics that would prompt me to ask my clinician to screen for peripheral artery disease.

Wei Zhang: First, if you feel some abnormality of your limb, like when you cannot walk as fast as you can, you feel some leg pain when you walk long distance, you feel some numbness, or you found some sore in your foot that cannot heal in time, you should go to the doctor. Tell the doctor if you have a family history of cardiovascular disease. Also do screening for hypertension, check your blood pressure, your blood sugar, and other lab screenings. That can let the doctor give you some screening of your basic situation to see whether it is necessary to refer you to the vascular specialist for advanced assessment.

I think for patients, especially when you have family or relatives with cardiovascular history, you need to pay attention to your own cardiovascular health because it is a genetic issue. It is also one important factor in cardiovascular disease.

Kevin Pho: I just want to add to that, of course, smoking history as well plays a huge role for peripheral artery disease.

Wei Zhang: Yes. Smoking and alcohol.

Kevin Pho: We are talking to Wei Zhang, postdoctoral researcher. Today’s KevinMD article is “Peripheral artery disease prevention: saving limbs and lives.” Wei, let’s end with take-home messages that you want to leave with the KevinMD audience.

Wei Zhang: I just want to emphasize that the pathway from vascular disease to limb loss is long, but the impact of amputation is profound. It can affect mobility, independence, dignity, and quality of life. Patient awareness remains limited. Also, primary care is the first and most important gatekeeper for early detection. So it is still underutilized in preventing artery disease progress.

Preventing limb loss requires coordinated and system-wide efforts from patients who recognize early symptoms to primary care, wound care, and vascular specialties. They need to work together to prevent these devastating outcomes. The disparities that we are seeing today are driven critically by unequal access to care and socioeconomic factors combined with workforce shortages. To really decrease limb loss, we need many parts of the work and efforts to work together to decrease limb loss and really improve quality of life.

Kevin Pho: Wei, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Wei Zhang: Thank you so much for having me.